Healthcare Provider Details

I. General information

NPI: 1194796821
Provider Name (Legal Business Name): MUTHU M RAMASAMY M.D., FRCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 RAILROAD AVE
COOPERSTOWN NY
13326-1394
US

IV. Provider business mailing address

1 ATWELL RD DEPARTMENT OF SURGERY, BASSETT HEALTHCARE
COOPERSTOWN NY
13326-1301
US

V. Phone/Fax

Practice location:
  • Phone: 607-547-7835
  • Fax: 607-547-8740
Mailing address:
  • Phone: 607-547-7835
  • Fax: 607-547-8740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number238263
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number238263
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number238263
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number238263
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number238263
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number238263
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: